MADAM SPEAKER
PRAYERS 10:35 a.m.
ANNOUNCEMENTS 10:35 a.m.
PRESIDENT OF THE REPUBLIC 10:35 a.m.
OF GHANA 10:35 a.m.
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VOTES AND PROCEEDINGS AND THE OFFICIAL REPORT 11:55 a.m.
ORAL ANSWERS TO QUESTIONS 12:15 p.m.
MINISTRY OF YOUTH AND SPORTS 12:15 p.m.
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PAPERS 12:45 p.m.
MR. FIRST DEPUTY SPEAKER
CONSIDERATION OF 12:55 p.m.
ANNUAL ESTIMATES 12:55 p.m.
ITEM PLANNED 12:55 p.m.
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ANNUAL ESTIMATES 1:55 p.m.
[MAJ. (DR.) (ALH.) AHMED (RETD) [MAJ. (DR.) (ALH.) AHMED (RETD) Care A study is underway to determine the level of performance of the procurement, supply and Va l u e f o r M o n e y ( V F M ) negotiations and statutory approvals of contracts for new projects such as the major refurbishment of the Tamale Teaching Hospital, expansion of Radiotherapy and Nuclear Medicine Centres at KBTH and KATH, construction of two (2) regional hospitals with staff housing at Wa and Kumasi were undertaken; and Other new projects which were subjected to VFM negotiations and for which contracts approved were the construction of six (6) district hospitals with staff housing at Adenta/Madina, Twifo-Praso, Konongo-Odumasi, Wenchi, Tepa, and Salaga; and the construction of the Blood Transfusion Centres at the teaching hospitals. Improved capacity of internal audit staff in MDAs and MMDAs resulting in 169 IAUs submitting Quarterly Internal Audit Reports. Internal auditors also benefited from training in Procurement Audit and Asset Management; Setting-up and establishment of 287 functional Internal Audit Units in MDAs and MMDAs out of a target of 341; Establishment of an Inspectorate Section of Government's Internal Audit Agency to facilitate action on internal audit reports including, where appropriate, recommen- da t ions of p rosecut ion and disciplinary action in respect of any breaches found after conducting an audit in MDAs and MMDAs; and Organisation of an Annual Internal Audit forum for 650 public service managers to deliberate on Performance Management and the role of Internal Auditing in the Public Sector. 7.0 Budget Projections for 2010 In promoting the Government's objective for the Ministry of Health, an amount of seven hundred and twenty-six million, eight hundred and seventy-one thousand, four hundred and forty-two Ghana cedis (GH¢726,871,442) has been allocated for activities for 2010. The breakdown is as follows: The amount provided would be committed to the following activities: 7.1 Malnutrition As part of efforts to achieve the health- related MDGs, nutrition will be a major focus of the sector. Essential nutrition actions will be implemented in all regions with emphasis on complementary and supplementary feeding of infants, children, pregnant women, nursing mothers and PLHIV technical support to the nutritional aspect of the School Feeding Programme. 7.2 Emergency Services Emergency health services will be strengthened by equipping and upgrading selected accident and emergency centres throughout the country. There will be pooling of ambulances from facilities to the National Ambulance Service (NAS). The focus will also be on developing capacities in the area of emergency care, especially through training of critical personnel at various levels and the provision of additional ambulance. 7.3 Private Sector Collaboration Government will continue to partner the private sector in the areas of developing collaborations for investments in the health industry, promoting welfare and supporting private healthcare delivery. Government will also collaborate with the local pharmaceutical industry to build capacity to international standards (WHO prequalification) and competitiveness. 7.4 National Health Insurance Scheme In order to ensure sustainable financing that will protect the poor, Government will improve the operations of NHIS, particularly claims management, communications and coverage of the poor and linking LEAP with NHIS. Government will also conclude preparatory activities for the implementation of the one-time payment of premiums. 7.5 Primary Healthcare Services As part of the strategies to enhance access to healthcare, Government will deepen the concept of Primary Healthcare by focusing more on the CHPS concept, which is very close to the client, while at the same time strengthening the referral system. Government will work with the SPACE FOR TABLE AT PAGE 110
[MAJ. (DR.) (ALH.) AHMED (RETD) [MAJ. (DR.) (ALH.) AHMED (RETD) District Assemblies and other stakeholders to increase the number of functional CHPS zones and upgrade the skills of CHOs. 7.6 Integrated Planning at District Levels Government will place emphasis on strengthening the district health information system to be able to capture all health information. District planning will also be enhanced to improve co- ordination, transparency and efficiency. 7.7 Health Laws and Regulations Government will continue to review, help to promulgate and implement relevant laws and regulations such as the Mental Health Law, Allied Health Law among others. 7.8 Specialized Tertiary Services Government will increase specialised tertiary services and efforts will continue to be made to establish specialised care and teaching facilities in the tertiary and regional hospitals as centres of excellence in order to provide quality specialised care and reduce expenditure on overseas treatment. 7.9 Other Communicable Diseases To strengthen the control of diseases in 2010, new malaria control measures will be introduced while HIV/AIDS prevention activities such as behavioural change communication strategies, knowledge of status campaign, and targeting at risk groups will be scaled up. Comprehensive care and support services towards achieving universal access will be scaled up. HIV sentinel survey will be undertaken and early infant diagnosis of HIV and capacity-building will be emphasized. Government also plans to introduce two new vaccines (Pneumonias I and Retrovirus) in 2011. However, preparatory activities for the introduction will commence in 2010 and will include training, social mobilization, technical support, supervisory visits, monitoring and feedback to regions and districts. 7.10 Non-communicable Diseases Prevention and control of non- communicab le d i seases such as hypertension, diabetes, sickle cell, cancers and mental disorders will be scaled up. 7.11 Human Resource Development Government will focus on addressing the challenges associated with the sector's wage bill and distribution of critical health staff. Training of middle level cadres such as mental health nurses and midwives will be scaled up and plans are on the way to upgrade post-basic programmes such as Public Health, Critical Care, Perioperative, Anesthesia and Ophthalmic Nursing to degree programmes. 7.12 Traditional Medicine Practice The official institutionalization of traditional and alternative complementary medicine services which began in 2009, would be expanded and strengthened to increase access to good practices in herbal and complementary medicine. Research will be carried on long-term safety and ethical manufacturing of the products into modern and convenient dosage forms under high quality control. In addition to the above, Government will develop data-bases and scientific information on herbal medicines to healthcare professionals and other stakeholders in the industry to enhance the rational and safe use of approved herbal medicines. 7 . 1 3 S t r e n g t h e n i n g H e a l t h Infrastructure As part of efforts to increase access to services, Government will continue with the extension, expansion, upgrading and equipping of polyclinics and health centres, district and regional hospitals and health training institutions. Other projects to be undertaken are: const ruct ion of off ices and laboratories for Food and Drugs Board; completion of works on training institutions nationwide; upgrading of 3 health centres to district hospitals with funding from OPEC; development of MIS and ICT infrastructure of NHIS; completion of selected ongoing projects in health facilities, DHMT and RHMT; construction and inaugurating of 5 polyclinics/health centres in the Northern Region at Karaga, Kpandai , Tata le , Janga and Chereponi and a 100-bed general hospital with Malaria Research Centre at Teshie, Accra; completion and inaugurating of the Korle-Bu Teaching Hospital Medical Block, and the GHS Learning Centre at Pantang; development, equipping and inaugurating of some CHPS compounds in selected sub-districts; planning activities including contractual issues, negotiations and s ta tutory approvals for the commencement of major rehabilitation and upgrading of Tamale Teaching Hospital, construction of 3 regional hospitals at Wa, Bolgatanga and Koforidua, district hospitals and staff housing at Madina/Adenta and Weija in Accra, Manhyia in Kumasi, Tepa, Salaga, Wenchi, Konongo-Odumasi and Twifo-Praso; preparatory activities for project commencement for the supply and installation of laundry and imaging equipment in selected health facilities, re-equipping of selected health facilities with various specialised medical equipment, expansion of Radiotherapy and Nuclear Medicine facilities at KATH and KBTH and the construction of the Blood Transfusion Centres at the teaching hospitals; execution of the construction of Winneba District Hospital, Tarkwa District Hospital and the maternity block at Achimota Hospital, Maamobi, Kaneshie and Mamprobi Polyclinics, maternity and the children's block at Tema General Hospital, and the phase 2 of the rehabilitation and upgrading of Bolgatanga Regional Hospital; continuation of ongoing projects such as other health sector projects in the districts including staff accommodation, DHMT and RHMT, offices for the Nurses and Midwifes Council, KATH Maternity and Children's Block; office complex for NAS and St. John's Ambulance, including the expansion of nurses' training institutions nationwide; preparatory works including feasibility studies, needs and site assessment, appraisals, value for money audits, tendering, negotia- tions, funds mobilization and required approvals for Specialized Urology Centre and Specialised Neurology Centre, both at Korle-Bu Teaching Hospital, maternity and children's hospital at Ridge Hos- pital, Accra; preparatory works will be done for the development of various regional and district hospitals, health centres, centres of excellence and equipment installations, medical assistants' training schools in Volta, Western and Northern Regions, upgrading of Cape Coast Regional Hospital into a teaching hospital; and the new Midwifery Training Schools in the Northern Region at Damango and Nalerigu. 8.0 Observations and Recommendations Personal Emoluments It was observed that funding of Personal Emoluments continues to be a challenge to the Ministry of Health since it forms about 95 per cent of the total Government of Ghana allocation of GH¢400,450,712 to the sector leaving just about 5 per cent constituting GH¢7,302,862 for financing of Items 2, 3, and 4 at the operational level. Internally Generated Fund contributions are therefore, used to support operations annually. It was also observed that the amount of GH¢377,600,000 provided for Personal Emoluments under GOG still falls short of the total wage bill of the Ministry by about GH¢91,540,000. The Committee recommen-ded that the Ministry of Health should liaise with the Ministry of Finance
[MAJ. (DR.) (ALH.) AHMED (RETD)
[MAJ. (DR.) (ALH.) AHMED (RETD) and Economic Planning to correct this anomaly to ensure that all staff are paid within the year. Abuja Declaration The Abuja Declaration to which Ghana is a signatory enjoins Government to commit 15 per cent of its total Budget to health. This has over the years not been complied with and although there have been aggregate increases in the budget of the Ministry of Health between 2004 and 2009, the Ministry's share of the total government Budget has suffered a steady decline in real terms from 11.7 per cent in 2005 to 8.2 per cent in 2009. The Committee, however, noted with satisfaction an increase of the Ministry of Health's share of the national Budget from 8.2 per cent to 13.85 per cent. The Committee urged Government to commit more funds to the operations of the Ministry of Health in realization of its commitments to the Abuja Declaration. Below is a table indicating the percentage increase in the Ministry of Health's share of the country's Budget from 2004 to 2009. Internally Generated Fund (IGF) It was observed that the Internally Generated Fund of the Ministry of Health has increased substantially from GH¢108,312 in 2009 to GH¢259,633 in 2010. The increase was attributed to a low projection of inflows for the 2009 fiscal year. The Committee, therefore, recommends the introduction of a better tracking system to capture IGF inflows effectively. It was again realised that departments under the Ministry overspend their allocated IGF without prior approval from the Ministry of Finance and Economic Planning. The Committee strongly urged the Ministry of Finance and Economic Planning to monitor and ensure the departments and agencies under the Ministry of Health do not spend beyond the approved IGF. National Health Insurance Scheme The Committee noted with concern the late release of funds to the National Health Insurance Scheme by the Ministry of Finance and Economic Planning. Out of the GH¢392.00 million to be transferred to the Scheme only GH¢ 201.50 has so far been released as per the Budget read on Thursday, 18th November, 2009. However, according to the NHIA, only GH¢92.00 million has so far been received. The discrepancy affected the transfer of funds to the mutual health insurance schemes as well as distressed departments and agencies under the Ministry of Health. The Committee recommended that if possible, a desk be created at the Ministry of Finance and Economic Planning to track transfers or releases to the NHIA. It was further recommended that the Ministry of Finance and Economic Planning should release funds to the NHIA on time since the revenue is tied to the Value Added Tax under section 86 of the National Health Insurance Act, 2003 (Act 650). In the opinion of the Committee, if the recommendations are adhered to, there would be early releases of funds to the mutual health schemes, hospitals and the Scheme would be protected from collapse. The NHIA should also endeavour to strictly adhere to recommendations by the august House. Investment Projects The Committee noted with concern that although certain projects were targeted for completion last year, they are yet to be awarded for execution. They include the rehabilitation of the six district hospitals at Adenta/Madina, Twifo-Praso, Konongo- Odumasi, Wenchi, Tepa, and Salaga. It was explained that the delay is as a result of gaps identified in the project documents presented to the Ministry of Finance and Economic Planning. The Ministry of Health promised to re- submit the documents for further review and approval within the year to ensure completion of the projects. The Committee admonished the Ministry of Health to expedite action on the review of the contract documents and commence work on the proposed projects as early as possible. Community- Based Health Planning and Services Compounds (CHPS) The Committee was again not satisfied with the amount of money allocated for the purchase of equipment for CHPS compounds. The Committee viewed the GH¢1,000,000 allocated as woefully inadequate. However, it was explained that additional funds have been provided under the National Ambulance Service budget to support the CHPS compounds. The Committee was not satisfied with SPACE FOR TABLE AT PAGE 114
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[MAJ. (DR.) (ALH.) AHMED (RETD) the explanation because the two projects are not related and asked that the National Ambulance Service programme should be decoupled from the development of the CHPS compounds to ensure adequate development of the CHPS compounds to the benefit of the rural poor. Budget Support Considering funds generated by some departments, like the Food and Drugs Board and the Pharmacy Council, the Committee was of the view that within three years, they should be able to carry out their activities without GOG support. It was, therefore, recommended that the Ministry should monitor the performance of these departments and within three years wean them off GOG budget support. Food and Drugs Board The Committee was gratified to know that all 50 cars owned by the Food and Drugs Board have been comprehensively insured. The Committee commended them for their initiative and foresight and encouraged them to insure their offices and equipment as well, if possible. The Committee was, however, not happy with funds expended on electricity and rental charges. It, therefore, urged the Board to expedite work on its office complex in order to cut down on cost incurred on electricity and rental charges. Korle-Bu Teaching Hospital It was observed that the Korle-Bu Teaching Hospital has too many specialists who have very little to do during the year because very few cases are referred to them. It was explained that Korle-Bu Teaching Hospital would adopt hospitals in southern Ghana that are in need of specialists and engage some of them there. The Committee was satisfied with the proposal and hoped it would be implemented within the year. It was also recommended that Tamale and Komfo Anokye Teaching Hospitals should also adopt hospitals in the northern sector. The Committee further recommended a review of charges at the hospital to increase internally generated funds which would assist in the defraying of debt owed by the hospital. Mental Hospital It was observed that an amount of GH¢118,000 meant for construction of a mortuary building at the Accra Psychiatric Hospital was not utilized. The fence wall to the Medical Director's residence was also constructed but not paid for. Even though the Estates Management Unit of the Ghana Health Service has submitted the detailed design of the mortuary project for review, the contract for the construction of the mortuary is yet to be awarded. It is the view of the Committee that action on the award of contract should be expedited to ensure early completion of the project. Komfo Anokye Teaching Hospital Renovation works on the maternity and childrens' block of the Komfo Anokye Teaching Hospital are still pending although it serves a large population in the Ashanti and adjoining regions. The Committee expressed worry at this development and urged that funds should be allocated in the ensuing year to complete the project in order to reduce congestion and the high maternal and infant mortality rate at the hospital. National Ambulance Service It was acknowledged that the National Ambulance Service contributes immensely to the provision of pre-hospital care to the sick and wounded by conveying them to health facilities on time. It, however, has only twenty-three ambulances operational throughout the country. These ambulances are not enough to satisfy the needs of the public. Funds were not, however, released for the purchase of new ambulances as expected in 2009. It is the hope of the Committee that funds would be released within the year to augment the current fleet. Tamale Teaching Hospital The Tamale Teaching Hospital has not seen any major renovation works since it was inaugurated in 1974. It was therefore gratifying to note that a loan of twenty- eight million euros (€28.00 million) has been secured by Government for major renovation works at the hospital. An amount of GH¢3.5 million has also been allocated as counterpart funding under the Ministry of Health's budget in support of the project by providing for doctors' accommodation. The Committee, however, observed with regret that allocated funds to the project have been captured under the Ghana Health Service and the Food and Drugs Board investment budget for 2010. The Committee was of the view that it would be difficult to access the funds under this arrangement. It, therefore, recommended that the funds should be lodged under the Office of the Minister for easy access. The law governing the hospital should also be reviewed within the shortest possible time to upgrade it to the status of a teaching hospital. Private Hospitals and Maternity Homes Board The Committee realised that although the Private Hospitals and Maternity Homes Board has accommodation and transportation problems, no provision has been made under investment to that effect. This, in the opinion of the Committee, would affect their operations within the year. The Ministry of Health was therefore requested to review the charges of the Board from GH¢20.00 to GH¢50.00 to enable them generate additional funds to support their activities. The law governing the Board should also be reviewed to give impetus to their operations. Pharmacy Council The third Board of the Pharmacy Council ended its mandate in October 2007. There is, therefore, no supervising authority to see to the operations and major decisions of the Council. The Committee recommended an early commissioning of the new Council to make room for improved performance within the year. Programmes under the Ministry of Health The Committee observed with concern that Ministry of Health could not account for major donor support programmes like the Malaria Control Programme, TB Control Programme and National AIDS Control Programme although they fall under its purview. Funds have again been committed to these programmes in the 2010 Budget. Considering the quantum of funds provided to these programmes, the Committee recommended that the Ministry of Health should take steps to monitor and account for these programmes. 9.0 Conclusion Health is not only a human rights issue but also a key driver of development and ultimately of wealth creation. It is, therefore, imperative that adequate resources are committed to the sector to ensure that lives are saved as expected. Funds committed to the activities of the Ministry are still not up to 15 per cent of the national Budget but the Committee is
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[MAJ. (DR.) (ALH.) AHMED (RETD) appreciative of the quantum increase and therefore, recommends that the House approves of the amount of seven hundred and twenty-six million, eight hundred and seventy-one thousand, four hundred and forty-two Ghana cedis (GH¢726,871,442) for the activities of the Ministry of Health for the 2010 fiscal year. Question proposed.
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[DR. ANANE) made was that because of the internally generated funds (IGF) -- and if care is taken of the IGF, some institutions could also be weaned off the Consolidated Fund. Institutions like the Food and Drugs Board and the Pharmacy Council are two such institutions which we hope the Hon Minister could take a good look at and, maybe, in the next two, three years consider weaning off the Consolidated Fund. We believe that if these institutions are weaned off and they are encouraged, other institutions will also be weaned off so that eventually the Consolidated Fund can be applied to other areas for the benefit of the people. Mr. Speaker, I said I only intended presenting my Paper to the Table for eventual placement in the Hansard, so I may not say much. But I want to call on the Hon Minister to take deliberate measures, deliberate policy decisions, backed with action, backed with decision-making so that some of the things that he wants to do could eventually come to fruition. But Mr. Speaker, before I sit down, the question of the Mental Health Law was raised several times and we want to draw attention to it so that it will be taken care of. So true is the issue of the Tamale Teaching Hospital. It was gratifying, while we were out at Swedru, to hear that the loan facility for the rehabilitation of the Tamale Teaching Hospital had been passed by the House. Mr. Speaker, we are happy about this. But we also think that one of the things that can help to place the Tamale Teaching Hospital as a teaching hospital is for the legislation to put it into that position. So,we call on the Hon Minister to take note and to quicken the pace of presenting that legislation so that
ANNUAL ESTIMATES 2:25 p.m.
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ANNUAL ESTIMATES 3:05 p.m.
MR. SECOND DEPUTY SPEAKER
CEDECOM 3:05 p.m.
NBSSI 3:05 p.m.
GEPC 3:05 p.m.
ANNUAL ESTIMATES 3:35 p.m.
SPACE FOR TABLE AT PAGE 3:35 p.m.
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ANNUAL ESTIMATES 5:05 p.m.
AIDS 5:05 p.m.
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ADJOURNMENT 5:25 p.m.
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